JAC-Antimicrobial Resistance最新文献

{"title":"Scoping review of risk-scoring tools for early prediction of bloodstream infections caused by carbapenem-resistant Enterobacterales: do we really have a reliable risk-scoring tool?","authors":"Abdullah Tarik Aslan, Yukiko Ezure, Patrick N A Harris, David L Paterson","doi":"10.1093/jacamr/dlae032","DOIUrl":"10.1093/jacamr/dlae032","url":null,"abstract":"<p><strong>Background: </strong>Bloodstream infections (BSIs) caused by carbapenem-resistant Enterobacterales (CRE) are a global health concern. Rapid identification of CRE may improve patient outcomes and reduce inappropriate antibiotic prescription. The use of risk-scoring tools (RSTs) can be valuable for optimizing the decision-making process for empirical antibiotic therapy of suspected CRE bacteraemia. These tools can also be used to triage use of expensive rapid diagnostic methods.</p><p><strong>Methods: </strong>We systematically reviewed the relevant literature in PubMed/MEDLINE, CINAHL, Cochrane, Web of Science, Embase and Scopus up to 1 November 2022 to identify RSTs that predict CRE BSIs. The literature review and analysis of the articles were performed by two researchers; any inconsistencies were resolved through discussion.</p><p><strong>Results: </strong>We identified 9 RSTs developed for early prediction of CRE BSIs and only logistic regression was used for most studies. These RSTs were quite different from each other in terms of their performance and the variables they included. They also had notable limitations and very few of them were externally validated.</p><p><strong>Conclusions: </strong>RSTs for early prediction of CRE BSIs have limitations and lack of external validity outside the local setting in which they were developed. Future studies to identify optimal RSTs in high and low CRE-endemic settings are warranted. Approaches based on rapid diagnostics and RSTs should be compared with a treatment approach using both methods in a randomized controlled trial.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 1","pages":"dlae032"},"PeriodicalIF":3.4,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10899000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139982971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Covariates in population pharmacokinetic studies of critically ill adults receiving β-lactam antimicrobials: a systematic review and narrative synthesis.","authors":"Jan Hansel, Fahmida Mannan, Rebecca Robey, Mary Kumarendran, Siân Bladon, Alexander G Mathioudakis, Kayode Ogungbenro, Paul Dark, Timothy W Felton","doi":"10.1093/jacamr/dlae030","DOIUrl":"10.1093/jacamr/dlae030","url":null,"abstract":"<p><strong>Introduction: </strong>Population pharmacokinetic studies of β-lactam antimicrobials in critically ill patients derive models that inform their dosing. In non-linear mixed-effects modelling, covariates are often used to improve model fit and explain variability. We aimed to investigate which covariates are most commonly assessed and which are found to be significant, along with global patterns of publication.</p><p><strong>Methods: </strong>We conducted a systematic review, searching MEDLINE, Embase, CENTRAL and Web of Science on 01 March 2023, including studies of critically ill adults receiving β-lactam antimicrobials who underwent blood sampling for population pharmacokinetic studies. We extracted and categorized all reported covariates and assessed reporting quality using the ClinPK checklist.</p><p><strong>Results: </strong>Our search identified 151 studies with 6018 participants. Most studies reported observational cohorts (120 studies, 80%), with the majority conducted in high-income settings (136 studies, 90%). Of the 1083 identified covariate instances, 237 were unique; the most common categories were patient characteristics (<i>n</i> = 404), biomarkers (<i>n</i> = 206) and physiological parameters (<i>n</i> = 163). Only seven distinct commonly reported covariates (CL_CR, weight, glomerular filtration rate, diuresis, need for renal replacement, serum albumin and C-reactive protein) were significant more than 20% of the time.</p><p><strong>Conclusions: </strong>Covariates are most commonly chosen based on biological plausibility, with patient characteristics and biomarkers the most frequently investigated. We developed an openly accessible database of reported covariates to aid investigators with covariate selection when designing population pharmacokinetic studies. Novel covariates, such as sepsis subphenotypes, have not been explored yet, leaving a research gap for future work.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 1","pages":"dlae030"},"PeriodicalIF":3.7,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10895699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect and sustainability of a stepwise implemented multidisciplinary antimicrobial stewardship programme in a university hospital emergency department.","authors":"Lukas Arenz, Annika Porger, Michaela De Michel, Alexandra Weber, Jette Jung, Heidi Horns, Sandra Gscheidle, Tobias Weiglein, Joachim Pircher, Johanna Becker-Lienau, Sophia Horster, Matthias Klein, Rika Draenert","doi":"10.1093/jacamr/dlae026","DOIUrl":"10.1093/jacamr/dlae026","url":null,"abstract":"<p><strong>Objectives: </strong>To explore effectiveness and sustainability of guideline adherence and antibiotic consumption after establishing treatment guidelines and initiating antimicrobial stewardship (AMS) ward rounds in a university hospital emergency department (ED).</p><p><strong>Methods: </strong>Data were gathered retrospectively from 2017 to 2021 in the LMU University Hospital in Munich, Germany. Four time periods were compared: P1 (pre-intervention period); P2 (distribution of guideline pocket cards); P3 (reassessment after 3 years); and P4 (refresher of guideline pocket cards and additional daily AMS ward rounds for different medical disciplines). Primary outcome was adherence to guideline pocket cards for community-acquired pneumonia, cystitis, pyelonephritis and COVID-19-associated bacterial pneumonia. Secondary outcomes were reduction in antibiotic consumption and adherence to AMS specialist recommendations.</p><p><strong>Results: </strong>The study included 1324 patients. Guideline adherence increased in P2 for each of the infectious diseases entities. After 3 years (P3), guideline adherence decreased again, but was mostly on a higher level than in P1. AMS ward rounds resulted in an additional increase in guideline adherence (P1/P2: 47% versus 58.6%, <i>P</i> = 0.005; P2/P3: 58.6% versus 57.3%, <i>P</i> = 0.750; P3/P4: 57.3% versus 72.5%, <i>P</i> < 0.001). Adherence increased significantly, not only during workdays but also on weekends/nightshifts. Adherence to AMS specialist recommendations was excellent (91.3%). We observed an increase in use of narrow-spectrum antibiotics and a decrease in the application of fluoroquinolones and cephalosporins.</p><p><strong>Conclusions: </strong>Establishing treatment guidelines in the ED is effective. However, positive effects can be diminished over time. Daily AMS ward rounds are useful, not only to restore but to further increase guideline adherence significantly.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 1","pages":"dlae026"},"PeriodicalIF":3.4,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10895698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracellular activity and <i>in vivo</i> efficacy in a mouse model of septic arthritis of the novel pseudopeptide Pep16 against <i>Staphylococcus aureus</i> clinical isolates.","authors":"Jean-Baptiste Mascary, Valérie Bordeau, Irène Nicolas, Marie-Clémence Verdier, Pierre Rocheteau, Vincent Cattoir","doi":"10.1093/jacamr/dlae025","DOIUrl":"10.1093/jacamr/dlae025","url":null,"abstract":"<p><strong>Objectives: </strong>Assessing the therapeutic potential of a novel antimicrobial pseudopeptide, Pep16, both <i>in vitro</i> and <i>in vivo</i> for the treatment of septic arthritis caused by <i>Staphylococcus aureus</i>.</p><p><strong>Methods: </strong>Seven clinical isolates of <i>S. aureus</i> (two MRSA and five MSSA) were studied. MICs of Pep16 and comparators (vancomycin, teicoplanin, daptomycin and levofloxacin) were determined through the broth microdilution method. The intracellular activity of Pep16 and levofloxacin was assessed in two models of infection using non-professional (osteoblasts MG-63) or professional (macrophages THP-1) phagocytic cells. A mouse model of septic arthritis was used to evaluate the <i>in vivo</i> efficacy of Pep16 and vancomycin. A preliminary pharmacokinetic (PK) analysis was performed by measuring plasma concentrations using LC-MS/MS following a single subcutaneous injection of Pep16 (10 mg/kg).</p><p><strong>Results: </strong>MICs of Pep16 were consistently at 8 mg/L for all clinical isolates of <i>S. aureus</i> (2- to 32-fold higher to those of comparators) while MBC/MIC ratios confirmed its bactericidal activity. Both Pep16 and levofloxacin (when used at 2 × MIC) significantly reduced the bacterial load of all tested isolates (two MSSA and two MRSA) within both osteoblasts and macrophages. In MSSA-infected mice, Pep16 demonstrated a significant (∼10-fold) reduction on bacterial loads in knee joints. PK analysis following a single subcutaneous administration of Pep16 revealed a gradual increase in plasma concentrations, reaching a peak of 5.6 mg/L at 12 h.</p><p><strong>Conclusions: </strong>Pep16 is a promising option for the treatment of septic arthritis due to <i>S. aureus</i>, particularly owing to its robust intracellular activity.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 1","pages":"dlae025"},"PeriodicalIF":3.4,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10895697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications.","authors":"Steward Mudenda, Robert Chilimboyi, Scott Kaba Matafwali, Victor Daka, Ruth Lindizyani Mfune, Loriane Arielle Mobou Kemgne, Flavien Nsoni Bumbangi, Jimmy Hangoma, Billy Chabalenge, Larry Mweetwa, Brian Godman","doi":"10.1093/jacamr/dlae023","DOIUrl":"10.1093/jacamr/dlae023","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) is a global public health problem that is fuelled by the inappropriate prescribing of antibiotics, especially those from the 'watch' and 'reserve' antibiotic lists. The irrational prescribing of antibiotics is particularly prevalent in developing countries, including Zambia. Consequently, there is a need to better understand prescribing patterns across sectors in Zambia as a basis for future interventions. This study evaluated the prescribing patterns of antibiotics using the WHO prescribing indicators alongside the 'access, watch and reserve' (AWaRe) classification system post-COVID pandemic at a faith-based hospital in Zambia.</p><p><strong>Methods: </strong>A cross-sectional study was conducted from August 2023 to October 2023 involving the review of medical records at St. Francis' Mission Hospital in Zambia. A WHO-validated tool was used to evaluate antibiotic prescribing patterns alongside the AWaRe classification tool.</p><p><strong>Results: </strong>Out of 800 medical records reviewed, 2003 medicines were prescribed. Each patient received an average of 2.5 medicines per prescription. Antibiotics were prescribed in 72.3% of encounters, of which 28.4% were injectable. The most frequently prescribed antibiotics were amoxicillin (23.4%-access), metronidazole (17.1%-access), ciprofloxacin (8%-watch) and ceftriaxone (7.4%-watch), with 77.1% overall from the 'access' list. Encouragingly, 96.5% of the medicines were prescribed by their generic names and 98% were from the Zambia Essential Medicines List.</p><p><strong>Conclusions: </strong>There were high rates of antibiotic prescribing, including injectable antibiotics, which needs addressing going forward. It is crucial to implement targeted measures, including antimicrobial stewardship programmes, to improve future antibiotic prescribing in Zambia and reduce the risk of AMR.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 1","pages":"dlae023"},"PeriodicalIF":3.4,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10883698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139931122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel zinc-chelating compound has antifungal activity against a wide range of <i>Candida</i> species, including multidrug-resistant <i>Candida auris</i>.","authors":"Takayuki Shinohara, Akira Wada, Masahiro Abe, Nobuko Nakayama, Minoru Nagi, Yoshitsugu Miyazaki","doi":"10.1093/jacamr/dlad155","DOIUrl":"10.1093/jacamr/dlad155","url":null,"abstract":"<p><strong>Objectives: </strong>In recent years, the incidence of invasive fungal infections has increased, resulting in considerable morbidity and mortality, particularly among immunocompromised individuals. Potential challenges in treating these infections with the few existing antifungal agents highlight the urgency of developing new ones. Here, we evaluated six alkyl polyamine compounds (APCs), not previously reported as antifungal drugs to our knowledge, that could deprive fungi of essential transition metals.</p><p><strong>Methods: </strong>The APC with confirmed antifungal activity against <i>Candida</i> spp. was analysed by using transcriptomics, followed by metal-addition experiments, mass spectrometric analyses and intracellular zinc quantification with a fluorescent probe.</p><p><strong>Results: </strong>A cyclic APC with three pyridylmethyl groups, APC6, had high antifungal activity against a wide range of <i>Candida</i> species, including MDR <i>Candida auris</i>. We conclusively demonstrated that APC6 was able to capture zinc within fungal cells. APC6 not only exhibited activity against <i>C. auris</i> as a single agent but also enhanced the efficacy of an azole antifungal agent, voriconazole, <i>in vitro</i> and <i>in vivo</i>. APC6 disrupted the biofilms formed by <i>Candida</i> species.</p><p><strong>Conclusions: </strong>This zinc-chelating compound has potential as an antifungal agent, and the control of zinc levels in <i>Candida</i> species could be a powerful approach to treating drug-resistant candidiasis.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 1","pages":"dlad155"},"PeriodicalIF":3.4,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10880073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139931121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of penicillin allergy labels on surgical site infections in a large UK cohort of gastrointestinal surgery patients.","authors":"Nick K Jones, Brian Tom, Constantinos Simillis, John Bennet, Stavros Gourgiotis, Jo Griffin, Helen Blaza, Shuaib Nasser, Stephen Baker, Theodore Gouliouris","doi":"10.1093/jacamr/dlae022","DOIUrl":"10.1093/jacamr/dlae022","url":null,"abstract":"<p><strong>Objectives: </strong>Studies in the USA, Canada and France have reported higher surgical site infection (SSI) risk in patients with a penicillin allergy label (PAL). Here, we investigate the association between PALs and SSI in the UK, a country with distinct epidemiology of infecting pathogens and range of antimicrobial regimens in routine use.</p><p><strong>Methods: </strong>Electronic health records and national SSI surveillance data were collated for a retrospective cohort of gastrointestinal surgery patients at Cambridge University Hospitals NHS Foundation Trust from 1 January 2015 to 31 December 2021. Univariable and multivariable logistic regression were used to examine the effects of PALs and the use of non-β-lactam-based prophylaxis on likelihood of SSI, 30 day post-operative mortality, 7 day post-operative acute kidney injury and 60 day post-operative infection/colonization with antimicrobial-resistant bacteria or <i>Clostridioides difficile</i>.</p><p><strong>Results: </strong>Our data comprised 3644 patients and 4085 operations; 461 were undertaken in the presence of PALs (11.3%). SSI was detected after 435/4085 (10.7%) operations. Neither the presence of PALs, nor the use of non-β-lactam-based prophylaxis were found to be associated with SSI: adjusted OR (aOR) 0.90 (95% CI 0.65-1.25) and 1.20 (0.88-1.62), respectively. PALs were independently associated with increased odds of newly identified MRSA infection/colonization in the 60 days after surgery: aOR 2.71 (95% CI 1.13-6.49). Negative association was observed for newly identified infection/colonization with third-generation cephalosporin-resistant Gram-negative bacteria: aOR 0.38 (95% CI 0.16-0.89).</p><p><strong>Conclusions: </strong>No evidence was found for an association between PALs and the likelihood of SSI in this large UK cohort, suggesting significant international variation in the impact of PALs on surgical patients.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 1","pages":"dlae022"},"PeriodicalIF":3.4,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10873540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predominance of multidrug-resistant bacteria causing urinary tract infections among symptomatic patients in East Africa: a call for action.","authors":"Antonio Maldonado-Barragán, Stephen E Mshana, Katherine Keenan, Xuejia Ke, Stephen H Gillespie, John Stelling, John Maina, Joel Bazira, Ivan Muhwezi, Martha F Mushi, Dominique L Green, Mike Kesby, Andy G Lynch, Wilber Sabiiti, Derek J Sloan, Alison Sandeman, John Kiiru, Benon Asiimwe, Matthew T G Holden","doi":"10.1093/jacamr/dlae019","DOIUrl":"10.1093/jacamr/dlae019","url":null,"abstract":"<p><strong>Background: </strong>In low- and middle-income countries, antibiotics are often prescribed for patients with symptoms of urinary tract infections (UTIs) without microbiological confirmation. Inappropriate antibiotic use can contribute to antimicrobial resistance (AMR) and the selection of MDR bacteria. Data on antibiotic susceptibility of cultured bacteria are important in drafting empirical treatment guidelines and monitoring resistance trends, which can prevent the spread of AMR. In East Africa, antibiotic susceptibility data are sparse. To fill the gap, this study reports common microorganisms and their susceptibility patterns isolated from patients with UTI-like symptoms in Kenya, Tanzania and Uganda. Within each country, patients were recruited from three sites that were sociodemographically distinct and representative of different populations.</p><p><strong>Methods: </strong>UTI was defined by the presence of >10⁴ cfu/mL of one or two uropathogens in mid-stream urine samples. Identification of microorganisms was done using biochemical methods. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion assay. MDR bacteria were defined as isolates resistant to at least one agent in three or more classes of antimicrobial agents.</p><p><strong>Results: </strong>Microbiologically confirmed UTI was observed in 2653 (35.0%) of the 7583 patients studied. The predominant bacteria were <i>Escherichia coli</i> (37.0%), <i>Staphylococcus</i> spp. (26.3%), <i>Klebsiella</i> spp. (5.8%) and <i>Enterococcus</i> spp. (5.5%). <i>E. coli</i> contributed 982 of the isolates, with an MDR proportion of 52.2%. <i>Staphylococcus</i> spp. contributed 697 of the isolates, with an MDR rate of 60.3%. The overall proportion of MDR bacteria (<i>n</i> = 1153) was 50.9%.</p><p><strong>Conclusions: </strong>MDR bacteria are common causes of UTI in patients attending healthcare centres in East African countries, which emphasizes the need for investment in laboratory culture capacity and diagnostic algorithms to improve accuracy of diagnosis that will lead to appropriate antibiotic use to prevent and control AMR.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 1","pages":"dlae019"},"PeriodicalIF":3.4,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10873138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot study to evaluate the need and implementation of a multifaceted nurse-led antimicrobial stewardship intervention in residential aged care.","authors":"Natali Jokanovic, Sue J Lee, Terry Haines, Sarah N Hilmer, Yun-Hee Jeon, Laura Travis, Darshini Ayton, Eliza Watson, Tess Tsindos, Andrew J Stewardson, Rhonda L Stuart, Allen C Cheng, Trisha N Peel, Anton Y Peleg","doi":"10.1093/jacamr/dlae016","DOIUrl":"10.1093/jacamr/dlae016","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the need and feasibility of a nurse-led antimicrobial stewardship (AMS) programme in two Australian residential aged care homes (RACHs) to inform a stepped-wedged, cluster randomized controlled trial (SW-cRCT).</p><p><strong>Methods: </strong>A mixed-methods pilot study of a nurse-led AMS programme was performed in two RACHs in Victoria, Australia (July-December 2019). The AMS programme comprised education, infection assessment and management guidelines, and documentation to support appropriate antimicrobial use in urinary, lower respiratory and skin/soft tissue infections. The programme was implemented over three phases: (i) pre-implementation education and integration (1 month); (ii) implementation of the intervention (3 months); and (iii) post-intervention evaluation (1 month). Baseline RACH and resident data and weekly infection and antimicrobial usage were collected and analysed descriptively to evaluate the need for AMS strategies. Feedback on intervention resources and implementation barriers were identified from semi-structured interviews, an online staff questionnaire and researcher field notes.</p><p><strong>Results: </strong>Six key barriers to implementation of the intervention were identified and used to refine the intervention: aged care staffing and capacity; access to education; resistance to practice change; role of staff in AMS; leadership and ownership of the intervention at the RACH and organization level; and family expectations. A total of 61 antimicrobials were prescribed for 40 residents over the 3 month intervention. Overall, 48% of antibiotics did not meet minimum criteria for appropriate initiation (respiratory: 73%; urinary: 54%; skin/soft tissue: 0%).</p><p><strong>Conclusions: </strong>Several barriers and opportunities to improve implementation of AMS in RACHs were identified. Findings were used to inform a revised intervention to be evaluated in a larger SW-cRCT.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 1","pages":"dlae016"},"PeriodicalIF":3.4,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10873136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of an inpatient penicillin allergy de-labelling pathway: capturing the patient voice.","authors":"Neil Powell, Mathew Upton, Bridie Kent, Jonathan Sandoe, Sarah Tonkin-Crine","doi":"10.1093/jacamr/dlae020","DOIUrl":"https://doi.org/10.1093/jacamr/dlae020","url":null,"abstract":"<p><strong>Background: </strong>Non-allergist-delivered penicillin allergy de-labelling (PADL) is supported by UK and other national guidelines but is not yet routine practice in UK hospitals. Those who have undergone PADL report high rates of acceptance, but it is unknown why some continue to avoid penicillin, and why some decline testing.</p><p><strong>Objectives: </strong>To explore the experiences of patients recently approached for penicillin allergy (penA) assessment and de-label by non-allergists in a UK hospital to determine the barriers and enablers to patient acceptance of PADL.</p><p><strong>Methods: </strong>Qualitative study using semi-structured interviews with patients who were penA assessed and de-labelled during an inpatient stay between November 2022 and January 2023. Thematic analysis was used to analyse the data.</p><p><strong>Results: </strong>Nineteen patients were interviewed. Patients were largely unaware of the negative impact of penA on their healthcare. Patients had differing views on challenging their penA status while they were acutely unwell, some agreeing that it is the right time to test and others not. Patients declined testing because they felt they were at higher potential risk because they were older or had multiple comorbidities. Some patients who declined testing felt they would have been persuaded if they had received a better explanation of the risks and benefits of PADL.</p><p><strong>Conclusions: </strong>Patients who were successfully de-labelled were positive about the experience. Those who declined testing did so for a variety of reasons including frailty/comorbidities or a fear of testing whilst unwell. Patients highlighted the importance of good communication about the personalized risks and benefits of testing.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 1","pages":"dlae020"},"PeriodicalIF":3.4,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139722536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}